This 29 years old mother have been affected with a sore, on and off, ingrown toenail on her left big toe for years.

Because her calloused nailfolds were pushing up against both nail sides, the nail got finally detached from the toe. This broke away the natural barrier at the distal end of the nail. Then the fungal micro-organisms got right into the open spaces under each side of her discolored and yellowish nail.

An ingrown toe nail procedure had been performed conservatively enough to preserve the natural outline of her left big toenail and the look of her feet. The immune system of this young lady was strong enough to push away the disfiguring fungal nail infection.

Here is the final picture showing how the appearance of her foot, toe and nail had been nicely preserved. At Ottawa Foot Clinic, we take pride in providing you such good looking and fungus-free end-results!

1. This young lady came to the clinic with a sore big toe, unable to tolerate closed shoes anymore. Not only sore, but red and swollen! Take a closer look at the red bulging skin just along the side her the big toenail. I mean the side of the big toenail closer to her second toe. But the patient came in at the right time. Just before bacterial toe infection kicks in.

2. We removed the nail polish. Red and swollen tissues along sides and tip of the nail are showing up much better. The withish spots at each side of the tip of her nail are signs of a mild fungal nail infection. The goals of the ingrown toenail procedure is to fix her nail to prevent any recurring pain episodes with toe infection and to help her immune system to clear the nail fungus out!
Know what are the two tiny bleeding points at the base of the big toe? These are the exact two spots where we froze her toe. We used a small needle to kindly and slowly inject a local anesthetic. This patient shared that she barely felt anything. Why? Because we pay a special attention so you each patient get a positive experience. We ‘’cold spray” and freeze the outer skin before we introduce the smallest needle. We inject real slow not to create tissue pressure.

3. A blue sterile elastic has been clipped around the base of the toe. This is to prevent oozing to ruin the necessary tissue contact with the solution in charge to incapacitate the lateral growth centres. A blunt spatula is gently pushed against the skin to make sure the toe is numb enough. Here, the patient only had a kind of pressure sensation. But no pain at all!

4. We then gently introduced the blunt spatula under the inner or medial side of the nail. It simply detaches the nail from the underlying tissues. No tissue is cut in any way.

5. Same spatula under the outer or lateral side of the nail.

6. A special nail cutter was used to cut the lateral side of the nail.

7. Both medial and lateral sides of this ingrown toenail are now cut.

8. A curved nail clamp will be introduced to gently grab and rotate the offending nail side and its root outside the tissues.

9. The underside of the excised nail side and its root are exposed. The root of the nail receives more blood vessels from the underlying growth centre. This why the base of this lateral nail side is a bit darker.

10. The ingrown lateral nail side and its root has been removed. We are left with the inner or medial side.

11. We have lifted the medial nail side and its roots out of the surrounding tissues at the inner side of the toe. See how
wide it is and how deep it was embedded into the tissues! See how big is the hook at the base of the root. No wonder it
was sore! As this nail is real thin, let’s look at another case.

12. The nail sides of this right big toe had been cut. And twisted out of the surrounding tissue. Appreciate how big are the hooks of each nail side and root!

13. The exposed nail side is being cut.

14. And removed.

15. The root is now being cut.

16. And removed.

17. Back to the left big toenail of our lady. Both nail sides and roots are removed.

18A. It is now time for phenol application using sterilized cotton tips soaked into the 90% solution

18B. The cotton tips soaked with phenol are on their way to be introduced down into the treatment areas.

19. The phenol is applied to both medial and lateral nail growth centres for 90 seconds to ensure that the ingrown nail sides won’t grow back in again. Never!

20. The phenol is an acid that neutralizes the cells responsible to grow the nail sides.

21. Proper phenol treatment makes tissues look white.

22. A sterile white non-adhesive tissue pad with antibiotic cream is placed right over the treatment area.

23. Sterile gauze is to be…

24. …placed.

25. Then an elastic self-adhesive bandage is precisely custom-made all around the toe.

26. The bandage is secured to the toe using tape so it will keep it in place for the next 48 hours.

27. This is how the toe and toenail look one week after the completion of the ingrown toenail procedure. Here also, both nail sides and roots had been excised and the nail growth centres had been treated with a 90-second phenol application.

28. One year or so after, the newly grown up big toenail will just look great! Just as it looks on this second picture on the right. In this case, the before and after pictures were taken 14 months apart. No more ingrown toenail and no more nail fungus!
Please note that recurrence of a treated ingrown toenail condition may happen. Whenever it does, we repeat same chemical matricectomy procedure. Either with a second but longer 90% phenol treatment (120 seconds) or with a 60-sec application of a 10% sodium hydroxide solution.
Also note that severe fungal nail infection (where over 50% of the nail is infected) will require a concomitant series of antifungal nail laser treatments to be instituted a few weeks after the matricectomy.

BEFOREANDAFTER1PIED

Whats Behind the Aches and Pains

Like a rusty hinge that makes opening and closing a door difficult, the joint pain and stiffness of arthritis can make it hard to bend or move. While there is no cure, there are plenty of things you can do to slow the progression and relieve symptoms. Thats good news for those who suffer from this condition in their feet and ankles, since there are more than 30 joints in the foot allowing for a wide range of movements. If pain or joint stiffness sets in here, it can make even standing or simply walking difficult.

Although there are many types of arthritis, the most common that affect the feet and ankles include:

Osteoarthritis  this is what is known as degenerative, meaning it is caused by wear and tear over time and the natural aging process. A breakdown of the cartilage that cushions the joints leads to inflammation, pain, and sometimes even deformity. This usually occurs slowly over many years.

Rheumatoid arthritis  a chronic, autoimmune disease, this type is the result of your body producing substances that attack your joints, damaging the bones, cartilage, and connective tissues. The exact cause is unknown, although it is believed that some people carry the gene which can be triggered by infection or environmental factors.

Posttraumatic arthritis  dislocations and fractures from the past can come back to haunt you! This type of the condition can set in and damage the affected joints cartilage even years after the initial injury.

What You Can Do to Ease Discomfort

Symptoms of arthritis include swelling, tenderness, redness, warmth to the touch, pain with motion or activity, and joint stiffness. Thats a long list, but believe it or not, with just a few changes, you can not only manage these symptoms, but live a full and active life.

Pain Laser treatments, anti-inflammatory medications or injections, synovial fluid replacement using Hyaluronate Acid (HA) solutions as Synvisc or Neovisc, compressive socks, ankle and foot supports and orthotics are all ways that can provide relief. A switch to a pair of shoes that offer support, flexibility, and are shaped like your foot can make a difference too. Stretching exercises are also beneficial, and although you may experience joint pain with movement, a great way to manage the pain, ironically, is to do just that move! Exercising can do wonders to minimize joint stiffness and pain. Low-impact options are best since they do not put excess stress on your joints. Try swimming or biking, for example.

Of course, if arthritis pain is too much and affecting your quality of life, surgery is also an option. Procedures range from removing osteophytes, replacing damaged cartilage and joints with the newest alternatives to fusion of the bones. Our foot specialists can assess your situation and help you decide the best course of action. If you are suffering from painful joints, call Ottawa Foot Clinic at (613) 595-9700 today. We can help you return to a full and active life, and close the door on joint pain. Come see us at our Ottawa, ON, Canada location, or visit us online.

Tarsal Tunnel Syndrome: Its Various Causes

Tarsal Tunnel Syndrome compresses the Tibial nerve as it travels along the inner leg. This foot condition causes pain and tingling in the ankles, pain radiating up the leg and into the foot, swelling of the heel, electric-like shocks, hot and cold sensations, and even a burning sensation starting at the bottom of the foot and going upward.

Naturally, this condition is most unpleasant and strange. Often patients will feel like their feet dont have enough padding but they dont know why. TTS can be caused by a variety of issues (including benign cysts, varicose veins or tendon sheath Inflammation), but its important for you to come in to Ottawa Foot Clinic and have the problem properly diagnosed and treated. Don’t delay!

Medical Pedicure: The Highest Standards of Care

Medical Pedicure is nail and foot care provided with a hospital-grade sterilization protocol by trained and qualified foot specialists, doctors of podiatric medicine and chiropodists. Each and every hand and rotative instrument that will touch your foot during your treatment will have been previously sterilized in an ultrasonic device, dried, bagged, and autoclaved in our in-office sterilization centre.

Our advanced foot care or medical-grade pedicure service is ideal for everyone, especially those at risk of cross contamination from a substandard unsanitary nail spa/salon working with infected instrumentation which does not go through an autoclave cycle.

Our trained staff regularly treat patients suffering from different ailments following visits to local unsanitary nail salons. The most common complaints are:

Athletes foot or fungal skin infection;

Onychomycosis or fungal nail infection;

Ingrown toenails from poorly cut nails;

Cellulitis or bacterial infection resulting from cuts to skin barrier;

Infection of a pre-existing diabetic ulceration.

Although athletes foot is treatable within a few 4-6 weeks with consistent twice-daily application of antifungal creams or foams, treating toenail fungus will require repetitive in-office laser sessions with a specific wavelength to kill the stubborn infesting micro-organisms (this is done over a 6 to 15 month-period). Mild to moderate ingrown toenails may be solved with nail braces to straighten up involuted nails while severe cases may require surgery. Cellulitis and diabetic ulceration at the least requires antibiotic treatment, but in its more serious stages can also result in toe or foot amputation and even death.

Currently, local government authorities are responsible for monitoring and legislating nail salon health standards; unfortunately the rising number of infections being spread suggests there is little being done to protect you.

At Ottawa Foot Clinic, sterilization procedures are of critical importance. We take very seriously our mission to provide you with the highest standards of cleanliness known to our profession.

How the Problem Originates

Nothing life threatening herejust an annoying, unsightly toenail problem that may have you hiding your feet and not wanting to participate in certain activities. Why go on suffering the embarrassment of thick, yellow, brittle nails, when there is help close by?

Toenail fungus is caused by a class of microorganisms called dermatophytes that burrow under your nail. The fungus is found all over the place, but certain risk factors increase you chance of falling prey to it. Being male, older, or diabetic increases your chances, as well as footwear that keeps your feet damp and frequenting public areas where people walk barefoot (pools, gym showers, or saunas).

The fungus slips into any tiny opening in your skincut, blister, rashor any separation between your nail and nail bed. It feeds on the hard tissue, causing those unsightly changes in your nails as they degrade. Because they dont stay on the surface, the fungi can be hard to eradicate, but laser therapy offers new hope.

How Laser Therapy Works

Laser treatment for fungal nails has been around for a while now, and there is evidence that it effectively destroys nail funguscalled onychomycosis. The method uses concentrated light beams of different wavelengths and focuses them on the site where the fungus thrives under the nail. Because it pinpoints the location so precisely, the fungus itself is vaporized, but the surrounding tissue is not harmed. Two separate wavelengths of light are used for the most effective treatment.

What the Treatment Is Like

The procedure is done right in our office. It is painless, has no known side effects, and does not require any anesthesia. We simply use a pen-like laser device to focus the light beams onto your toenails. A treatment takes about 20 minutes, and after that you are free to put on your shoes and walk out as you came inno recovery time is needed. We usually do treatments once a week for 3 weeks, and then again at week 8, depending on the extent of your infection.

We design a 4-pronged approach for treating fungal nails that combines laser therapy with treating your shoes to destroy the fungus, using antifungal creams on the skin around your nails, and applying an antifungal sealant to the nails after a laser treatment. If the nails are in really poor shape, we can add our nail restoration after the third treatment, so you can have more attractive toes while the new, healthy nail grows out.

Experience Pays

We know our laser therapy plan works, because we designed it based on our own experience with difficult toenail fungus, and because we have helped many patients in the capital district who have come to Ottawa Foot Clinic for help in treating fungal nails. Dont wait any longer; the earlier treatment starts, the easier and quicker it is to get rid of your toenail fungus. Call our Ottawa, Ontario office today at (613) 595-9700 to set up an appointment, or schedule one through our website.

What is an Ingrown Toenail?

Also known as onychocryptosis, this very common condition occurs when the nail excessively curves and begins to rub and dig deeply into the nailfolds. This often causes inflammation, pain, and an increased risk of infection. The cause of the toenails curve can usually be traced to ill-fitting shoes placing excessive pressure on the nail, although heredity or injury to the toe can sometimes be factors as well.

How are Ingrown Toenails Treated?

Mild cases of ingrown toenails can often be resolved conservatively at home, but conditions that are especially painful, appear to be infected, or keep returning should be examined by a professional. By no means should someone ever engage in bathroom surgery, trying to cut out an ingrown toenail at home. This most often only leads to further pain and a much greater chance that the toe will become infected.

In severe cases, the most efficient treatment for an especially painful or persistent problem is a full removal of the nail sides, followed by the destruction of the nail growth centers via a chemical application. This procedure is referred to as a matrixectomy, and often results in the nail never growing back.

A matrixectomy procedure can be performed in our office with local anesthesia, under the full attention and care of foot specialist. It is, of course, not the only option that may be available, and more conservative methods will be employed first if they might be effective.

For help with ingrown toenails and other painful conditions, contact Ottawa Foot Clinic at (613) 595-9700 to schedule an appointment with our Deakin Street office.

Sever’s Disease: Causes and Treatments

Sever’s disease, or calcaneal apophysitis, is a common cause of heel pain among active children between 10 to 13 years old. This spontaneous heel pain results from injury to the heel bones growth plate which is caused by overuse rather than specific injury or trauma. The condition is common among athletic children, particularly those active in soccer, football, and baseball.

Children are at a higher risk of developing Sever’s disease when they are in the early stages of a growth spurt. During times of growth, muscles and tendons become extremely tight. Movements during athletic activities like soccer, tennis, and gymnastics can put added force on the growth plate in the heel, which is pulled tight by the Achilles tendon. Over time, the growth plate becomes inflamed and painful.

There are several factors that increase a child’s risk of developing Sever’s disease, including:

Excessive pronation.

Flat or high arches.

Short Achilles tendon.

Weight gain (which results in more force on the feet).

Sever’s Disease Symptoms

The pain associated with Sever’s disease is usually felt along the back of the heel and becomes worse when running or walking. In some children, the pain is so severe they may limp when walking. One of the diagnostic tests for Sever’s disease is the “squeeze test”. Squeezing both sides of the heel together will produce immediate discomfort. Many children feel pain immediately upon waking and may have calf muscle stiffness in the morning.

Treatment of Sever’s disease

Parents can assist with the treatment of Sever’s disease by making sure their children reduce physical activity until pain subsides. A Doctor of Podiatric Medicine may recommend flexibility exercises, custom orthotics and anti-inflammatory laser treatments. In severe cases, a splint or soft cast may be necessary to immobilize the foot and give it a chance to heal. Most cases of Sever’s disease will resolve by the age of 16, when growing subsides. But severe and permanent damages with the tendon and its bony insertion may happen if the inflammation is not treated fast enough. Call Ottawa Foot Clinic now to have your child’s heel pain condition assessed and treated to avoid permanent damages!